Quinidine for Pharmacological Cardioversion of Long-lasting Atrial Fibrillation.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Long-lasting Atrial Fibrillation (n=90). Intervention: Quinidine vs. Amiodarone or Propafenone. Primary outcome: Conversion to sinus rhythm within 24 hours (RR 2.67, p=0.006).

Q: What does this research mean for the field?

Oral quinidine is significantly more effective than amiodarone or propafenone for pharmacological cardioversion of long-lasting atrial fibrillation without causing serious adverse effects. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Matteo Baroni; Antoine Kheir; Margherita Manfredi; Francesco Pattarino; Flavio Doni

doi:10.4022/jafib.350

July 15, 2011

Quinidine for Pharmacological Cardioversion of Long-lasting Atrial Fibrillation.

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Why the study?

Does quinidine improve conversion to sinus rhythm within 24 hours in patients with long-lasting atrial fibrillation compared to amiodarone and propafenone?

Study Design

Type

RCT (n=90)

Blinding

Open-label

Randomization

Randomized 1:1:1

Multicenter

No

Structured PICO

Does quinidine improve conversion to sinus rhythm within 24 hours in patients with long-lasting atrial fibrillation compared to amiodarone and propafenone?

P

Population

90 adult patients (mean age 64, 46.7% female) with long-lasting atrial fibrillation (>6 weeks) and adequately anticoagulated, randomized to quinidine, amiodarone, or propafenone and followed for 24 hours.

I

Intervention

Quinidine arabogalattan sulphate 275 mg oral every 2 hours up to 4 doses (8 hours maximum).

C

Comparator

Amiodarone (5 mg/kg IV bolus then 15 mg/kg over 24h) or Propafenone (2 mg/kg IV bolus then 0.007 mg/kg over 2h).

O

Outcome

Conversion to sinus rhythm within 24 hours after administration of drugssurrogate

Main Result

Relative Risk: 2.67

Absolute Event Rate: 53% vs 20%

p-value: p=0.006

Limitations

Small sample size compared to major pharmacological trials
Short observation period limited to a few hours of hospital setting
Lack of mid and long-term follow-up
Small sample size
Short follow-up restricted to hospital setting (no mid or long-term follow-up)
Unavoidable switch to another drug for prophylaxis may confound further observation

Implication

Quinidine provides a safe, highly effective oral strategy for cardioversion in long-lasting atrial fibrillation, substantially outperforming standard intravenous amiodarone and propafenone.

Abstract

Quinidine seems to be safe and effective in pharmacological cardioversion of long-lasting AF.

Discussion

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Cite This Study

Baroni et al. (2011) conducted an RCT in Long-lasting Atrial Fibrillation (n=90). Quinidine vs. Amiodarone or Propafenone was evaluated on Conversion to sinus rhythm within 24 hours (RR 2.67, p=0.006).

synapsesocial.com/papers/6a6f3c4c8031ec7bb1dba845 https://doi.org/10.4022/jafib.350

View Full Paper

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Quinidine for Pharmacological Cardioversion of Long-lasting Atrial Fibrillation.

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Quinidine for Pharmacological Cardioversion of Long-lasting Atrial Fibrillation.

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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